Early stage drug discovery is a key bottleneck in the pipeline to find novel drugs for tuberculosis, say Martina Casenghi (MSF) and colleagues.The lack of candidate compounds is “cause for alarm,” they say, given the global emergence of strains of TB that are resistant to current TB drugs.The authors argue that the few drug companies engaged in TB drug development are risk averse, generally embarking on drug development only when given evidence of rigorously validated targets and lead compounds that inhibit them. As a result, it has fallen largely to academia to undertake early stage drug discovery.